How do you relieve SI joint pain?

 

Physical therapy is one of the best ways to relieve SI joint pain. If a course of physical therapy doesn’t help, many get relief with corticosteroid injections. Rarely some patients elect to get surgery to fuse their SI joint. Apart from trauma cases, surgery to fuse the SI joint is always elective. SI joint pain is something that I see frequently in my practice as an orthopedic surgeon in Colorado Springs. It can often be mistaken for back pain, and can plague a patient for months if no one recognizes it.

What is the SI joint?

The SI joint stands for the sacroiliac joint. The sacroiliac joint is where your spinal column connects to your pelvis. You have two SI joints, one on each side and they are located right below your lower back and a few inches off center. If you have “low back pain” that is really low and off center, then you might actually have SI joint pain.

How do you relieve SI joint pain?

The SI joint is a complicated joint that shares the weight of your entire upper body and trunk. The biomechanics are complicated, but suffice to say that if your biomechanics of your SI joint get out of alignment, then it will move abnormally. Whenever a joint moves abnormally it can cause pain. The first and best step to relieve your SI joint pain is to do a course of physical therapy. A formal physical therapy is preferred, but if you can’t do that, then doing exercises on your own such as in this video can help. The exercises aim at strengthening the muscles around the SI joint to provide stability and prevent abnormal motion. This should in turn cause less irritation and pain in the SI joint. Physical therapy is always the first step that I recommend in my orthopedic surgery practice in Colorado Springs. 

Anti-inflammatories can be helpful, as well as a pelvic belt. The pelvic belt wraps around your hips and helps to stabilize your SI joints. It can help in the short term, but the true solution to relieve your SI joint pain is to strengthen the muscles around the SI joints with physical therapy. Sometimes even with physical therapy, some of my patients will still have significant pain. At that point I recommend a steroid injection of the SI joint. A steroid injection to the SI joint can really decrease the inflammation in the joint and allow greater progress with physical therapy. These injections have to be done under x-ray or ultrasound imaging. 

If you still have pain after physical therapy or a steroid injection to your SI joint, you can try tertiary therapies such as prolotherapy where they inject glucose into the joint to help scar it down and stabilize it, or radiofrequency ablation which burns some of the SI joint sensory nerves. Most people don’t end up needed to try prolotherapy or radiofrequency ablation. Rarely, if all else fails then some will do a SI joint fusion, which is a surgery where the SI joint is fully fused and not allowed to move. There are many different ways to perform this surgery, and it is not done all that often. Some swear by it, while others have mixed results.

I hope I was able to answer your questions about, how do you relieve SI joint pain. If you still have any questions or want to schedule an in person or virtual consult, please feel free to contact me.

-Written by Dr. Daniel Paull

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